AEGiS-14IAC: Monitoring and diagnostic tools for the management of antiretroviral therapy in resource-poor settings.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Monitoring and diagnostic tools for the management of antiretroviral therapy in resource-poor settings.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10174)

Gonsalves GS, Cheng B
Gay Men's Health Crisis, New York, United States

BACKGROUND: In November 2001, Gay Men's Health Crisis and Project Inform sponsored a scientific workshop to identify: the role of laboratory vs. clinical monitoring in the management of antiretroviral therapy (ART) in the developing world; the role of current tools in use or in development, in the diagnosis of HIV infection and the monitoring of immunological and virological status and response to therapy in these settings; future research priorities, including the need to develop less expensive and complex technologies.

METHODS: 100 scientists and clinicians from the developed and developing world met for two days to present data on these topics and make recommendations for action.

RESULTS: Based on data presented, we can conclude that: total lymphocyte count and clinical staging can predict risk of disease progression, but that additional studies comparing strictly clinical vs. laboratory monitoring in the management of ART need to be conducted; standard flow cytometry and viral load assays are too complex and costly to be used except at the most sophisticated research centers in the developing world; simpler, less expensive alternatives must be developed and evaluated, including modified flow-based and manual methods (e.g. dynabeads or cytospheres) for CD4 testing. There are few alternative viral load tests that are suitable for the developing world, although an optimized p24 antigen protocol (Schupbach et al. J Med Virol 2001) and other assays in development may be useful in these settings.

CONCLUSIONS: The effectiveness of using CD4 and viral load testing in the management of ART in the developing world needs to be assessed, especially if clinically based protocols may offer equivalent results. New simple, inexpensive, rapid, convenient, point-of-care assays (e.g. dipstick technologies) need to be developed and evaluated for clinical use, while the prices of existing technologies need to be dramatically reduced. Specific recommendations will be discussed.

Keywords: AEGIS, Viral Load, Health Resources, HIV Infections, Antiretroviral Therapy, Highly Active, Disease Progression, Lymphocyte Count, Poverty, Prognosis, Drug Therapy, Combination, Human, Male, diagnosis, therapy, organization & administration, drug therapy

020707
B10174